The Kindest Cut

COURTESY OF THE NATIONAL KIDNEY FOUNDATION
In 1954 Richard Herrick, confused and near death from kidney failure, was a patient at the Boston Public Health Service Hospital. His doctor, upon learning that he had a healthy identical-twin brother, referred Richard to the Peter Bent Brigham Hospital in Boston, where a kidney transplant program had just been initiated. At that time, doctors knew that the only instance of successful transplantation in humans was in skin grafts between identical twins.

The kidney transplantation team at Brigham had been started by George W. Thorn, physician in chief in medicine, and supported by Francis D. Moore, surgeon in chief. Renal dialysis, the so-called "artificial kidney," served as a temporary method for treating nephritis, or kidney inflammation. And kidney transplants from cadavers had offered minimal temporary function. Patients and families were desperate to try anything that might offer a longer term solution.

As a young surgeon in Dr. Moore's department, I had recently returned from three years service in the Army Medical Corps treating battle casualties from Europe, Africa and the Pacific. I had joined the hospital's transplant team because I had been intrigued watching the slow rejection of foreign skin in World War II burn victims. How could the human body be so smart as to tell the difference between its own and another's skin? Would the same limitation apply to organ transplants? Would a kidney transplanted between identical twins function permanently, as skin grafts did? Two years of laboratory study in dogs gave partial answers. We learned that a solitary kidney transplant without a genetic barrier could function normally.

When Richard Herrick arrived at Brigham, he had little time left. Anything that could be done to save his life was worth trying. Yet we doctors are taught first and foremost to "Do no harm." To subject Ronald, his healthy identical-twin donor, to a major operation not for his own benefit was radical thinking. The pressure within the medical community to succeed was immense. So, too, was the pressure from the Greater Boston community at large.

The doctors involved-John P. Merrill (nephrologist), J. Hartwell Harrison (Ronald's surgeon) and myself (Richard's surgeon)-consulted with colleagues, clergy of all denominations and legal counsel. Some felt we should not play God; others thought that if we failed, the field of organ transplantation could be set back by decades. In the weeks leading up to the operation, we conducted 17 tests to prove that the twins were genetically identical. Reciprocal skin grafts decisively proved the point. After four weeks, all grafts had healed without visible or microscopic sign of rejection.

As a team we presented all the information to the Herrick brothers and their family: the required preparations, risk of anesthesia, possible complications, and the longer term risk of developing pathology. Our responsibility as physicians is to inform patients and their families as fully as possible. The final decision was theirs. They decided to put their trust in our hands.

Although I had done hundreds of successful kidney transplants in dogs, Moore and I decided to do a precautionary ¿dry run¿ on a cadaver to establish that the dog operation was adaptable to humans. We found that a transplanted kidney would fit perfectly. Three days later, on December 23, 1954, we performed the Herrick transplants. The night before, Richard wrote a note to his brother that read: "Get out of here and go home." Ronald jotted off a quick reply: "I am here and I am going to stay."

The operation was an immediate success. Richard went on to marry the nurse who had cared for him. Together they had two children, one of whom works today as a nurse in a dialysis unit. Sadly, Richard died eight years later when chronic nephritis developed in his transplant.

Ronald became a teacher and now lives with his wife in New England. In late January he and his family joined me at Brigham for a film session honoring the 50th anniversary of the transplant. When he saw the oil portrait of the operation that hangs at the nearby Countway Library, at the Harvard Medical School, tears came to his eyes-and mine. We hugged each other firmly; we did not have to speak.

In the intervening years our laboratory and clinical work had continued: In 1959 we had achieved a successful kidney transplant between nonidentical twins. In 1962, the year Richard died, another historic operation had taken place at Brigham: the first successful cadaveric kidney transplant, in a patient treated with immunosuppressive drugs. These breakthroughs effectively opened the doors for organ transplantation as we know it today.

Similar advances in immunology and cell biology have turned what in 1954 seemed to be science fiction into reality. Today, organ transplants save lives daily. In fact, the biggest challenge is a shortage of donor organs. More than 83,000 people are on the national waiting list.

This summer more than 2,000 transplant recipients, young and old, from all over the country convened in Minneapolis for the National Kidney Foundation U.S. Transplant Games and celebrated the 50th anniversary of transplantation. As honorary chairman, it was a wonderful opportunity to truly recognize the ultimate expression of human altruism.

Like a pebble tossed into a placid pond, the effects of Ronald Herrick's selfless decision continue to reverberate.